[Talus bipartitus]. / Talus bipartitus.

Talus bipartitus is an exceptional congenital malformation consisting in the presence of two non-fused bony talar fragments. We report the case of an adolescent girl who complained of mechanical pain in the left ankle which became increasingly invalidating. Plain radiographs, CT-scan and MRI led to the diagnosis of this congenital anomaly: talus bipartitus. Surgical correction by subtalar arthrodesis provided improvement at the cost of reduced ankle mobility. Surgical treatment should be proposed for talus bipartitus in patients with invalidating pain or stiffness when rehabilitation fails to provide sufficient improvement.

Management of seat-belt syndrome in children. Gravity of 2-point seat-belt.

We present our experience with a management of seat-belt syndrome in three children and draw particular attention to the severity of two-point fixation seat-belt injuries after a motor vehicle accident with 5 passengers whose vehicle was struck head-on by an oncoming vehicle. The parents were sitting in front, Adeline had a 2-point lap seat-belt, the 2 other children had 3-point seat-belts. The parents both had humerus fractures. The 4-year-old brother suffered a cervical and abdominal trauma with renal and splenic contusions and intestinal perforations. Adeline suffered multiple injuries, notably to the head, spine and abdominal viscera with erosions at the site of lap-seat-belt contact. The spinal injury was an L2 angular Chance fracture associated with paraplegia on the 7th day. Operative findings included a transverse tear of the left rectus abdominus muscle, an incomplete transection of the stomach and perforation of the ileum. The injuries were ultimately fatal. Given associated abdominal pain, skin erosions at the site of seatbelt contact, spinal fracture, and rectal muscle disruption apparent on emergency laparotomy, early diagnosis is important for better prognosis.

Polylactide acid pins versus stainless steel pins in the treatment of diaphyseal fracture: Experimental study in rats.

In order to develop a biodegradable pin for diaphyseal femoral fracture fixation, polylactide acid (PLA) pins were implanted in the femoral bone of rats. A distal diaphyseal fracture was performed. Union and tissue reaction to PLA pins versus stainless steel pins was studied after 15 days, and 1, 2 and 6 months of implantation. PLA and stainless steel pins induced the same union and a similar tissue reaction during the 6-month period. Biocompatibility of material was satisfactory.

Absence of congenital prethrombotic disorders in children with Legg-Perthes disease.

Resistance to activated protein C (RPCA) and other congenital prethrombotic disorders have been recently reported to be strongly associated with Legg-Perthes disease. RPCA and deficiencies of protein C, protein S, and antithrombin III were sought in 22 children with Legg-Perthes disease. Detection of the factor V Leiden mutation was found in children with RPCA. Twenty-two healthy children paired by age and sex served as controls. The prevalence of congenital prethrombotic disorders was not found to differ significantly among patients with Legg-Perthes disease and among control subjects. Only one patient had RPCA; this patient was heterozygous for the factor V Leiden mutation. Twenty patients and all the control subjects had entirely normal coagulation results. The authors conclude that unless more data become available, RPCA and deficiencies of protein C, protein S, and antithrombin III should not be considered associated with Legg-Perthes disease.

Osteosynthesis of diaphyseal fracture by Ossatite experimental study in rat.

In order to develop a biodegradable interlocking nail for fracture fixation, hydoxylapatite pins and paste were implanted in the femoral bone of rats. A distal fracture was performed. The union and the tissue reaction to hydroxylapatite versus stainless-steel rods were studied after 15 days, 1, 2 and 6 months implantation. Metal pins induced a union. Hydroxylapatite pins (Ossatite) did not prevent callus formation, but did not lead to consolidation in all cases due to weakness of gelatin matrix binding the apatite particles together. The biocompatibility of material is satisfactory and the osteo-inductive properties of hydroxylapatite was confirmed. With injectable Ossatite , we could not obtain rat femoral fracture consolidation. We can confirm good biomaterial tolerance in bone which contrasts with important soft tissue reactions. Use of such material should be carefully limited to filling intra-osseous cavities.

Intramedullary nailing of forearm fractures in children.

Forearm fractures are very common in children. They are usually treated orthopedically. For the last few years, Métaizeau's elastic stable nailing has been used in the authors' hospital. This study is based on 80 children with forearm fractures treated with intramedullary nailing: 64 boys and 16 girls, aged 6 to 16 (23 right sides, 58 left sides: 81 fractures). Nailing was performed 67 times for a displaced fracture, 3 times for a recurrent fracture, 3 times after a secondary displacement, and 7 times in patients with multiple injuries. Sound union was normally achieved in 78 patients, and normal motion in 79. Ten children experienced complications, but only complications involving the skin and sepsis were due to the technique. The seven skin complications (three in the ulnar fractures, and four in the radial fractures) consisted of three major local infections, one radial osteomyelitis, and three minor local nonunion of skin. One patient had limited thumb extension, and two patients fell a second time. One advantage of the method described here is that plaster casts are avoided, allowing children to go back to school early. Sound union is achieved as quickly as with orthopedic treatment, and recovery is excellent.

Diaphyseal fractures treated by polylactide and hydroxyapatite pins. Experimental study in rat.

In order to develop a biodegradable interlocking nail for fracture fixation, polylactic acid (PLA) pins and hydoxyapatite pins were implanted in the femoral bone in rats. A distal fracture was performed. The union and the tissue reaction to PLA and hydroxyapatite versus stainless steel rods were studied after 15 days, 1, 2 and 6 months implantation. Metal and PLA pins induced a union. Hydroxyapatite pins (Ossatite) did not prevent callus formation, but did not lead to consolidation in all cases because of weakness of the gelatin matrix binding the apatite particles together. PLA and stainless steel pins induced the same union and a similar tissue reaction during the studied implantation of 6 months. The biocompatility of Ossatite is satisfactory and the osteo-inductive properties of hydroxyapatite was confirmed. With injectable Ossatite, we could not obtain rat femoral fracture consolidation. We can confirm good biomaterial tolerance in bone which contrasts with important soft tissue reactions. Use of such material should be carefully limited to filling intra-osseous cavities.

Melorheostosis: complications of a tibial lengthening with the Ilizarov apparatus.

Melorheostosis is a rare bone dysplasia, exceptionally described in childhood. It has been discovered in a 12-year-old boy who had a hemimelic affection associated with straw-berry skin marks. A 25 mm inequality of length of the lower limbs and a valgus deformation of the ankle resulting in a claudication and gonalgia requiring surgical correction. A reaxation and a progressive lengthening with the Ilizarov apparatus has been performed. Non-consolidation and a secondary bone infection led to the necessity of formation of a soleus flap. Consolidation and healing were finally obtained. In addition to vascular complications to be feared in this disease during surgical treatment, we have to take into consideration the absence of consolidation when the osteotomy is not performed on a safe bone.

[Percutaneous drainage of septic hip arthritis in children]. / Drainage percutané de l'arthrite septique de hanche de l'enfant.

INTRODUCTION: Hip arthritis is a therapeutic emergency which requires sure diagnosis and pus evacuation. Two methods are presently in use: isolated or oriterative punction and arthrotomy. TECHNIQUE: A Pleurocath is introduced under general anesthesia and under fluoroscopic control by an obturator approach. It contains a perforated trocart which allows a flexible catheter, perforated over the last few centimeters to be inserted. The introduction point must be as far posterior as possible, in the plane of the anterior border of the femoral neck to promote declivious downward. It allows for pus evacuation, confirmation of the diagnosis and bacteriological samples to be taken. The lavage is done using ionized polyvidone dilution in physiological saline solution. The catheter is inserted in the center of the trocart and pushed intra-articularly under fluoroscopic control. The trocart is pulled out. The catheter is fixed on the skin using non resorbable thread. An occlusive dressing is made. A three way cock is installed for aspiration and lavage. Drainage is declivious. MATERIAL AND METHODS: This percutaneous drainage technique was used in three cases of septic hip arthritis in children. Treatment associated drainage, immobilization by traction and double or triple intravenous antibiotics. The hips healed without any detrimental effects. DISCUSSION: The punction had both a diagnosis and a therapeutic objective, as it allows pus evacuation in the same time. It can be repeated according to the patient's progress. Most authors prefer arthrotomy with careful lavage and good drainage. We suggest an intermediate technique which includes punction and allows clinical and bacteriological diagnosis, joint lavage and drainage. Using permanent drainage, the hip joint is protected from high pressure. It makes repeated lavage possible when the pus is thick, and avoids the drain from becoming plugged. CONCLUSION: This approach enables the pus to be evacuated, bacteriological samples to be taken, lavage and drainage. The drainage must be left until apyrexia and normal biological inflammation criteria are obtained.